Provider First Line Business Practice Location Address:
9507 N DIVISION ST STE C4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-710-1471
Provider Business Practice Location Address Fax Number:
509-838-6827
Provider Enumeration Date:
10/24/2005